Combining information technology and human research efforts to lessen personnel burden and costs One success story

Objectives: Develop a coding system to extract EHR data and establish research validity to lessen need for manual data extraction Methods: As part of a data collection project for COVID + patients requiring ICU care, we established data elements able to be extracted from the Epic electronic health record (EHR). Collaboration between Information Technology (IT), research and clinical personnel established where data elements were located within the EHR and what data could be extracted with minimal manual assistance and uploaded to a research database. Coding was developed using Structured Query Language (SQL) with best practices (includes indexes, execution plans, optimized range keys, avoiding large reads inside read-write transactions as instructed by the Epic consultant). Accuracy of extracted data was evaluated by manual validation of data against Epic records via random selection of patient data within the cohort. Result(s): From July-December 2022, coding was developed which extracted over 130 fields of data from 3093 COVID patients across 5 INOVA ICU sites (demographic, physiologic, lab, interventions, outcome). Prior efforts at data extraction of these elements from research personnel (ZS) who previously performed this task noted an average of 4 hours/patient to complete coded fields. Coded data was also noted to be more accurate when accessed by the same personnel to manually extracted fields. Assuming 4 hrs/pt, manual extraction would require 12,372 hours, which equates to over 6 full time human research personnel. Data coding required 446 hours. Coded data extraction can be almost immediate once fields requested are established, decreasing personnel costs and effort significantly. Conclusion(s): Reduction in need for manual data collection using automated coding extraction can reduce costs, personnel time and enhance research efforts. Sharing coding mapping to other EPIC sites or use of similar methods may improve timeliness of ongoing data extraction and will be useful to develop earlywarning and patient-centered care algorithms to improve care.

Negative ageism and compassionate ageism in news coverage of older people under COVID-19: how did the pandemic progression and public health responses associate with different news themes?

Previous studies have found negative ageing narratives in the media during the COVID-19 pandemic. However, few have focused on compassionate ageism and how the news responded to the progression of the COVID-19 pandemic. We investigated (a) media themes of negative and compassionate ageism and (b) their relationships with COVID-19 parameters and the public health response. The sample included 1,197 articles relevant to COVID-19 and older people in Hong Kong published between January and December 2020. We used thematic analysis to identify themes from the news articles and structural equation modelling to explore these themes' relationship with the number of older people infected, effective reproduction number, number of COVID-19 deaths and public health response parallel in time. Pandemic-related variables were lagged for a day - the time needed to be reflected in the news. Two negative ageism themes portrayed older people as vulnerable to COVID-19 but counterproductive in combating the pandemic. Two compassionate ageism themes depicted older people as a homogenous group of passive assistance recipients. The theme blaming older people was associated with the number of confirmed infections (beta = 0.418, p = 0.002) but vulnerability of older people was not associated with pandemic-related variables. The theme helping older people was negatively associated with the percentage of older people in confirmed infections (beta = -0.155, p = 0.019). The theme resources available was negatively associated with confirmed infections (beta = -0.342, p < 0.001) but positively associated with the Containment and Health Index (beta = 0.217, p = 0.005). Findings suggested that negative and compassionate ageism were translated into narratives about older people in the media as the pandemic evolved but did not address the actual risk they faced. Media professionals should be aware of the potential negative and compassionate ageism prompted by the news agenda and promote adequate health behaviours and responses.

Utilization of the Youth Quitline as an opportunity for an undergraduate nursing students to deliver smoking cessation counseling as their clinical placement: An implementation of a service-learning model.

BACKGROUND: Smoking is an important modifiable risk factor of morbidities and mortality. Although healthcare professionals play an important role in smoking cessation, their adoption of such practices is relatively low because of inadequate training. To address this issue, we incorporated a service-learning model to operate the Youth Quitline. Undergraduate nursing students were trained and received supervision while delivering smoking cessation counseling through the Youth Quitline as their clinical placement. OBJECTIVES: We evaluated the effectiveness of the placement by assessing students' knowledge, attitudes and practices regarding smoking cessation and tobacco control. DESIGN: One-group pretest-posttest design. SETTING: Youth Quitline. PARTICIPANTS: A total of 61 third-year students in a mental health nursing program. METHODS: Students were required to complete 80 h at the Youth Quitline. The 80 h were divided into 20 sessions; students used four sessions to approach and recruit youth smokers in the community, then provided them with telephone counseling for the rest of the time. Prior to the placement, students attended a 2-day workshop. The outcomes were changes in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control 3 months after the placement compared with baseline. RESULTS: From January-June 2021, students conducted 105 outreach activities to identify 3142 smokers in the community, and provided telephone counseling for 336 smokers via Youth Quitline. Compared with baseline, significant improvements were observed in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control at 3-month follow-up. CONCLUSIONS: The clinical placement improved students' knowledge, attitudes and practices regarding smoking cessation and tobacco control, enhancing their competency in providing support to assist smokers to quit in their future practice. Incorporating the service-learning model in existing community-based services can provide additional venues for nursing students to practice. This is particularly important because many venues have restricted access during the COVID-19 pandemic.

Adolescents' attitudes to the COVID-19 vaccination.

Vaccines against COVID-19 are now available for adolescents in Hong Kong but vaccine hesitancy is a major barrier to herd immunity. This survey study explores Hong Kong adolescents' attitudes towards the COVID-19 vaccination. 2609 adolescents from across Hong Kong completed an online survey focused on the intent to vaccinate and the reasons for their choice. 39% of adolescents intended to take the COVID-19 vaccination and significant factors for this decision include: having at least one parent vaccinated, knowing somebody diagnosed with COVID-19 and receiving the influenza vaccine. Adolescents' major concerns were either the safety and efficacy of the vaccine or the risk of infection. This study has proved that even in adolescents the vaccine hesitancy model is prominent with adolescents' intentions highly related to confidence in the vaccine and perception of disease risk. Future interventions should target these specific concerns to ensure adolescents are well educated to overcome vaccine hesitancy.

The impact of sars-cov2 infection in children with liver disease: An international observational registry study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) on children with underlying liver disease (LD) is unknown. We aim to report outcomes for pediatric patients with LD from the joint North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the Society of Pediatric Liver Transplantation (SPLIT) SARS-CoV2 registry Methods: We collected data from patients younger than 21 years with LD from 6 countries and laboratory-confirmed SARS-CoV2 infection reported to a multicenter observational cohort study between April 2020 and May 2021. Results: Seventy-three (59% male,55% white, 23% Hispanic) children with a median age of 9 years were reported in the registry. The most common causes of LD were biliary atresia (22%) followed by autoimmune hepatitis (16%) and non-alcoholic fatty liver disease (16%). Five patients (7%) presented in acute liver failure (ALF);all recovered without the need for a liver transplant. Four patients presented with multisystem inflammatory syndrome in children (2 with ALF, 2 without ALF) with one death reported. The most common presenting symptoms were constitutional (49%) including fever and fatigue followed by respiratory symptoms (47%). Twenty two percent (n=16) of patients were asymptomatic at the time of diagnosis. Twentythree percent had radiologic evidence of pneumonia and 14% reported co-infections. Median peak INR was 1.4, peak total bilirubin 2.9 (mg/dl), peak ALT 129 (IU/l) and nadir albumin 3.1 (g/dl). Sixty-four percent of patients required hospitalization;40% (n=19) in the ICU and 60% (n=28) non-ICU for a median of 6 and 7 days, respectively. Twenty-two percent of patients required respiratory support including mechanical ventilation (n=6), high-frequency oscillatory ventilation (n=3), highflow nasal cannula (n=5) and regular nasal cannula (n=2) for a median of 6 days. Nine patients required vasoactive agents, 3 required renal replacement therapy and 2 patients required ECMO. Sixty-six percent did not receive any SARSCoV2 directed treatment. Twelve (16%) patients developed new liver-related complications including ascites (n=9), GI bleeding (n=2), encephalopathy (n=3), progression of endstage liver disease (n=2) and infection (n=1). There were a total of 3 (4.1%) deaths (20yr, 17yr and 6month of age at time of death) reported secondary to acute on chronic liver failure with respiratory failure and multiorgan failure Conclusion: Contrary to healthy children, almost 2/3rd pediatric patients with LD testing positive for SARS-CoV2 required hospitalization with death reported in 4% of cases. Acute liver failure is rare with SARS-CoV2 infection with recovery reported without the need for liver transplantation. Close monitoring is needed due to an increased risk of underlying liver disease complications and death, particularly in children with end-stage liver disease awaiting transplantation.

The psychological impacts of a COVID-19 outbreak on college students in China: a longitudinal study

An outbreak in Wuhan, China in late 2019 of a highly infectious new coronary pneumonia (COVID-19) led to the imposition of countrywide confinement measures from January to March 2020. This is a longitudinal study on changes in the mental health status of a college population before and after their COVID-19 confinement for the first two weeks, focusing on states of psychological distress, depression, anxiety and affectivity. The influence of possible stressors on their mental health were investigated, including inadequate supplies and fears of infection. Five hundred and fifty-five undergraduate students were recruited from Hebei Agricultural University in Baoding, China. The participants completed two online surveys-on anxiety and depression, and on positive and negative affect. One survey was conducted before the confinement and the other was conducted 15-17 days after the start of the confinement. Increases in negative affect and symptoms of anxiety and depression (p-values < 0.001) were observed after 2 weeks of confinement. Inadequate supplies of hand sanitizers, a higher year of study, and higher scores on anxiety and depression were common predictors of increased negative affect, anxiety, and depression across the confinement period. The results suggest that healthcare policymakers should carefully consider the appropriate confinement duration, and ensure adequate supplies of basic infection-control materials.

Assessing the filtration effectiveness of a portable ultraviolet air cleaner on airborne sars-cov-2 laden droplets in a patient room: A numerical study

It has been confirmed that SARS-CoV-2 can infect humans via airborne transmission from person to person. Accordingly, there are two concerns about the exhaled airborne SARS-CoV-2 aerosol emitted from the coughs or sneezes of COVID-19 patients: (1) It might infect healthcare providers in the same confined patient rooms;(2) It might enter the main ventilation system and transmit to other patient room as a health threat. Therefore, a portable ultraviolet (UV) air cleaner is designed to mitigate the exposure risks to SARS-CoV-2 laden droplets in the patient room. Using the experimentally validated computational fluid-particle dynamics (CFPD) model, this study simulated the airborne transmission, deposition, and clearance of the COVID-19 virus-laden droplets emitted from a virtual patient in a virtual patient room with realistic ventilation conditions and various operating conditions of the portable UV air cleaner. Parameter analysis was performed to investigate how the ventilation conditions and the operation conditions of the sanitizer can influence the effectiveness of the filtration, which are quantified by the reduction of the concentration of virus-laden droplets suspended in the room and escaped from the room into the main ventilation system. Results indicate that the air cleaner is effective in virus-laden droplets clearance if placed in appropriate locations. In addition, maximizing the ventilation flow rate of the air cleaner will provide the best mitigation effect, with the highest filtration efficiency. © 2021, AAGR Aerosol and Air Quality Research. All rights reserved.

Liver transplant in a recently COVID-19 positive child with hepatoblastoma

Background: The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has transformed innumerable aspects of clinical practice, particularly in the field of organ transplantation As outcomes data remain scarce and a definitive treatment has yet to be realized, it is anticipated that transplant of an actively or recently COVID-19 infected patient could result in an adverse outcome Meanwhile, it is important to acknowledge that withholding or delaying transplant can lead to increased morbidity or death in some patients We describe the successful pediatric liver transplant for unresectable hepatoblastoma in a 4-year-old formerly premature male with COVID-19 infection prior to transplant. The first negative nasopharyngeal (NP) swab was documented one month after initial diagnosis, when SARS-CoV-2 antibodies were also detected The patient was therefore actively listed for orthotopic liver transplant after completing four blocks of a SIOPEL-4 based regimen due to his PRETEXT IV disease which remained unresectable Following three additional negative NP swabs and resolution of symptoms for four weeks, he underwent a whole-organ pediatric liver transplant Methods: COVID-19 positivity determined via NP swab SARS-CoV-2 real-time RT-PCR (Hologic Aptima SARS-CoV-2 RT-PCR assay) IgG and IgM total SARS-CoV-2 antibodies detected via Ortho Clinical Diagnostics VITROS®nodiagnostics Products Anti- SARS-CoV-2 Test Results: Patient received standard prednisone and tacrolimus-based immunosuppression without induction therapy following transplant Post-transplant course was remarkable for neutropenia and thrombocytopenia, which were closely followed, with discharge home on posttransplant day #11 Prior to discharge, RT-PCR testing was repeated three times and each test did not detect SARSCoV- 2 RNA Additionally, SARS-CoV-2 antibodies persisted at four weeks after transplant Conclusion: We describe one of the earliest, if not the first case of liver transplant following recent recovery from COVID-19 in a pediatric patient with a lethal malignant liver tumor A better understanding of how to balance the risk profile of transplant in the setting of COVID-19 with disease progression if transplant is not performed is needed It remains imperative that we provide life-saving liver transplants to children amid the COVID-19 pandemic while recognizing that transplant with any active viral infection typically portends worse outcomes In addition, the safety of our healthcare team remains a priority To meet these goals, we followed existing guidance to document clearance of the viral infection and resolution of symptoms and only then performed the transplant This case highlights that liver transplant can be safely performed in a child upon documented clearance of active COVID-19 infection with adherence to current guidelines and close follow-up.

Factors Affecting Trends in Societal Indicators of Ageing Well in Hong Kong: Policies, Politics and Pandemics.

OBJECTIVES: To document the trend in a quality of life indicator for the older Hong Kong population as an assessment of the impact of age friendly city policies, political conflicts and the covid-19 pandemic. DESIGN: Random telephone survey and collection of government data over four years (2017-2020). SETTING: Community living older people. PARTICIPANTS: People aged 50 years and over. MEASUREMENTS: The Hong Kong Quality of Life Index covering four domains of in income security, health status, capability and enabling environment. RESULTS: From 2017-9, improvements were seen in various domains in parallel with the adoption of the World Health Organization's Age Friendly City concept by government policy together with a territory wide initiative supported by a major philanthropic organization. However scores of all domains dropped markedly as a result of political conflicts as well as the onset of the pandemic. CONCLUSION: The documentation of the trend in HKEQOL shows that while it may be used as a macro indicator that is able to reflect policies affecting the well-being of older people, it is also able to reflect the impact of societal unrest and pandemics, and that the latter may override the effect of existing ageing policies. It also follows that during social unrest and pandemics, specific policies targeting older people may be needed to maintain well-being.

Consensus guidelines for interventional cardiology services delivery during covid-19 pandemic in Australia and new Zealand.

The global coronavirus disease (COVID-19) pandemic poses an unprecedented stress on healthcare systems internationally. These Health system-wide demands call for efficient utilisation of resources at this time in a fair, consistent, ethical and efficient manner would improve our ability to treat patients. Excellent co-operation between hospital units (especially intensive care unit [ICU], emergency department [ED] and cardiology) is critical in ensuring optimal patient outcomes. The purpose of this document is to provide practical guidelines for the effective use of interventional cardiology services in Australia and New Zealand. The document will be updated regularly as new evidence and knowledge is gained with time. Goals Considerations.